HSCI Trends & Issues

•Italy obesity. ______ for women, over_______ for men

35%;53%

In Finland ____ obesity for women, almost ____ for men

40;60%

◦______ obesity of women in France and _______ for men

41%;66%

◦________ obesity in women in Ireland and over _______ for men

48%;66%

•Spain obesity. more than ________ for men and______ in women

50%;46%

•Portugal obesity. women almost______ , ________ men

50%;60%

◦Over______ of obesity in women in England and _______ for men

57%; 66%

____________ societies today are highly patriarchal

African

Extended family important since tribal times Disrupted during slave period 43% of families headed by women Multigenerational homes common Children are highly valued

African American Families

___________ view life as energy rather then matter

African's

______ appear to eat more animal protein, total fat, sugar, fiber, cholesterol and less starch

American Irish

•Tight nuclear family with father in charge of finances and mother ruling home life.

Austrian

◦Clothing and tailoring, mining ◦Bakeries, meatpacking operations, and restaurants

Austrian

American family patterned after _______ family -Solitary family homes -Father in charge of public and business affairs -Mother in charge of social and domestic affairs -Well educated

British

______ diet among highest in animal products, potatoes, sweets, refined/processed items

Central European

•English may be second language •Illiteracy common •"Man's worth is in his girth" •May seek care only in emergencies •May refuse injections •Impure •Will bring food to patients •Contamination feared

Counseling: Gypsy Americans

-Open and willing to detail symptoms -Women may be modest -May seek advice from family and friends first -Prefer providers who are warm and empathetic -May be concern about the quality of their blood -GI complaints -May be language difficulties

Counseling: Italians

Many feel ailments/treatments not understood in US Culture specific ailments not familiar in US Medical care in Russia drugs with alternative treatments Prefer injections over oral meds May self medicate Assertive in US as they had to be assertive in Russia Many are highly acculturated

Counseling: Russians

•Russians expect more formality •May always respond "no" •Direct and possible loud communication •3 quick kisses and handshake common greeting •Direct eye contact •Preventive medicine unfamiliar •Compliance issues with medication or lifestyle changes •Avoid mental health care

Counseling: Russians

Low context communicators Highly analytical Emotions controlled Superficiality and personal inquiries are avoided Danes are less formal Direct eye contact Firm, brief handshake Other touching is reserved for friends and relatives Sickness considered a weakness Will avoid talking about it

Counseling: Scandinavians

-Conversational style animated, warm, expressive -Feelings more important than objective facts -Shaking hands, pats on back, embraces, kisses on cheek appropriate -Steady eye contact with younger people -Touching very common

Counseling: Southern Europeans

•High context •Polychronistic • Quick handshake •Personal space less •Direct eye contact desired •Higher percentage of illiteracy in elders, immigrants in US

Counseling: Spain/Portugal

◦Sales, machinist, or white-collar jobs ◦Founded businesses in cigars, beer and watches

Czech

•Male dominated with many relatives. •Slovaks •Strong family ties with respect for parents.

Czech and Hungarian

-Ukrainian and Lithuanian early immigrants were single men who were basically forced to intermarry with other ethnic groups. -Men dominate the household -Women run the home -Extended family is the norm -Armenians are tight-knit with respect for elders maintained -All are similar to the average American household

Families: Former Soviet Union

•Maintain extended family •Temporarily band together while traveling with multifamily groups. •Father in charge of all public matters •Women take care of family income and manage all money matters •Retain power due to ability to communicate with the supernatural world •Arranged marriages are common

Family: Gypsies

Traditionally large families Women legally dependent on their husbands Changing ◦Families are smaller due to women working and with more education ◦Still maintain all household chores Russian families have fewer children Education emphasized ◦Russian language

Family: Russians

-Maintained strong family bonds -Cajun families very large

French

monochronistic •Formal, polite, respect education and titles •Direct eye contact and handshake

Germans

◦Some maintain aspects of their heritage ◦higher in economic achievement and are generally conservative in attitudinal ratings ◦Heavy anti-German sentiment after WWI ◦Rapid assimilation

Germans

◦Traditionally large families on farms, later in businesses. ◦Pennsylvania Dutch (descendants of German immigrants) and the Amish still have large families

Germans

◦Highest in fats and oils of animal origin ◦50% German woman are obese, 66% for men

Germany

Beer is served at cellar temperature and is naturally carbonated

Great Britain and Ireland

•Tea •Introduced in 1662 by the wife of Charles II •A meal or break in the afternoon •Strong black tea with milk and sugar

Great Britain and Ireland

◦Tradition of roaming, are very mobile ◦Independent trades and service positions ◦Women are often in the mystical arts

Gypsies

◦Urban, white collar workers ◦Engineers

Hungarians

•Classic Cuisine •Haute or grande •Elegant, formal •Restaurants •Finest ingredients throughout the country •Provincial or regional cooking •Simpler fare •Home or local café •Fresh local ingredients

Ingredients and Common Foods: France

-Animal products of key importance •Sausages (bangers) •Ploughman's lunch •Fish and Chips •Devonshire double and clotted cream •Breads •Potatoes -Berries -Kitchen gardens -Seaweed -Fruits and vegetables that grow well in cool climates •Beverages •Tea, beer, whiskey •Pubs -Beer is served at cellar temperature and is naturally carbonated

Ingredients and Common Foods: Great Britain and Ireland

Britain: Bitters Ireland: Stout Ireland: Whiskey Scotland: Scotch WHISKY Mead

Ingredients and Common Foods: Great Britain and Ireland

•Largest producer of olives in the world •Eggs •Tortilla Española •Potato omelette that is the national dish •Serrano Ham •Paella •Saffron seasoned rice with various toppings •Gazpacho •Pureed vegetable soup served cold •Flan •Milk and egg custard with caramel •Sangria •Chilled wines with fruit juices

Ingredients and Common Foods: Staples of Spain

Pasta made with or without eggs Hundreds of shapes Most common is flat noodle: Tagliatelle •Olive oil •Labeled according to processing and % acidity Northern Italy ◦Fresh stuffed pasta ◦Topped with rich sauces Uses more butter, dairy, rice, and meat Southern Italy Dried, unfilled Tomato based sauce More olive oil, fish, beans, and vegetables All use parsley, basil, and oregano Largest consumer of rice in the world!

Ingredients and Common Foods: Staples of Italy

•More herbs and spices than Spain •Cilantro, mint, cumin •FISH dominates diet •Bacalhau •Dried salt cod •Sardines •Caldo Verde •Green soup

Ingredients and Common Foods: Staples of Portugal

_____ eat more calories but have lower weight

Irish

-Married later and had larger families -Strong position of the mother

Irish Catholics

_______ population consumes more plant products than protein

Italian

High in cholesterol and fat, low in fiber and complex carbohydrates

Northern Europe

US meals similar to

Northern Europe

Largest American ethnic groups from

Northern and Southern Europe

-Good diet -Plenty of sleep -Daily exercise -Fresh air -Cleanliness -Keeping warm and dry -Irish wear protective religious medallions -French use salves of whiskey, and camphor or tallow and turpentine -May consult voodoo practitioners

Northern and Southern Europeans Traditional Health Beliefs and Practices: Health Maintenance

•Boston Study: •High rates of HTN, Type 2 Diabetes, Vascular disease •Obesity at 85% •Chronic renal insufficiency •Europe •Dyslipidemia, obesity and insulin resistance •At risk for genetic problems •PKU •Galactokinase deficiency •Citrullinaemina •Wilson's Disease •Metchromatic Leucodystrophy •High rates of infant mortality and unfavorable birth outcomes •Life expectancy overall is low

Nutritional Status: Gypsies

Immigrant nutritional deficiencies from lack of vegs/fruit Dietary selenium deficiency, moderate iron and manganese deficiencies High rates of diabetes, HTN, HLD, CVD, TB, HIV Leukemia and thyroid cancer rates increased ◦80% of Russian immigrants from regions affected by Chernobyl May resist x-rays

Nutritional Status: Russia and FSU

Strongly support breastfeeding High rates of iron-deficiency anemia and endemic goiter Heavy alcohol use in Russia, some FSU nations and Poland High rates of gastric cancer Lithuania ◦Due in part to a high consumption of salted and cured meats and fish Homemade cheeses with unpastuerized milk ◦Increased risk of listeria Eggs sometimes used raw in uncooked dishes ◦Increased risk of salmonella

Nutritional Status: Russia and FSU

•Eating nonnutritive substances •Clay, chalk, laundry starch most common •Milk or magnesia, coffee grounds, plaster, ice, paraffin •Most often practiced by black women during pregnancy and postpartum •Common in the South

Pica

quieter than Americans •Uncomfortable with loudness •Handshake and direct eye contact

Poles

◦Just below or solidly at middle-class level ◦Formation and leadership in labor unions

Poles

◦Patriarchal with mother caring for home. ◦Wives and children rarely worked outside the home

Poles

_________ consume diet high in saturated fats, sodium, sugar

Recent Russian and FSU immigrants

◦White collar families with high incomes ◦Strong family and cultural ties likely

Slovak

-70% making steady economic progress -middle class is growing -Economic gap narrowing -Poverty rate, unemployment rate still double -High school graduation rates lower -Strong ethnic identify -Geographically, politically, and socioeconomically diverse -Recent immigrants often come for educational opportunity and/or are well educated

Socioeconomic Status of Africans

•Traditional Southern black cuisine •Fresh meats and vegetables made from scratch •Thoroughly cooked •Well-spiced •Symbol of ethnic solidarity

Soul food

-Dietary deficiencies and excesses similar to the majority of Americans -In US most are completely acculturated ◦Traditional dishes for special occasions -Consume more milk and meat -Less fish, fresh produce, and legumes -Olive oil used often, but exclusively -Pasta remains popular

Southern Europe

•All are Catholic countries •Church helps maintain traditions, culture •Family •All have strong family orientation •Father works, mother cares for home •Basque women have long history of equality

Southern Europe

•Christmas •Mardi Gras (Shrove Tuesday) •During Lent, no eggs, fat or meat are eaten •Easter

Special Occasions: France

•Christmas •Boxing Day •Easter •New Year's Day Burn's Night •St. Patrick's Day

Special Occasions: Great Britain and Ireland

•Buffet meal •Means "bread and butter table" •Large variety of hot and cold dishes •Served with Aquavit •Starts with herring, then other fish dishes Meats and salads •Hot dishes like Swedish meatballs and mushroom omelets •Dessert •Today served only on special occasions

Swedish Smörgåsbord

◦Multicultural, multilingual ◦Work in Swiss companies

Swiss

Chicken soup ◦Diarrhea, vomiting, sore throats Tea ◦Upset stomach Milk with honey ◦Coughs Pennsylvania Dutch ◦Cold drinks are unhealthy ◦Eat meat 3 times per day ◦Herbal teas for many complaints

Therapeutic Use of Food: Germans

•Fresh food most nourishing •Leftovers unwholesome •Canned and frozen items not fresh •Non-Gypsies carry disease •Use disposable plates and utensils in public places •Insufficient intake of lucky foods cause poor health •Salt, pepper, vinegar, garlic •Home remedies are common Tea with crushed strawberries •Asafetida (devil's dung) •Ghost vomit (Fuligo septica)

Therapeutic Use of Food: Gypsies

Butter ◦Eyesight Dill ◦Dyspepsia Honey ◦Flatulence Gogomul ◦Egg yolk, sugar, milk, baking soda ◦Respiratory infections Teas Raspberry, chamomile, eucalyptus, cornsilk Alcoholic beverages ◦Kvass cures hangovers Balsam flavored vodka ◦Cures anything Vodka with herbs ◦Supplement ◦Consumed as a shot ◦Added to coffee or tea Full hearty meals ◦To maintain health

Therapeutic Use of Food: Russia & the FSU

•Maintain health by 3 meals daily •Hot Breakfast •Variety of "blood" complaints •High blood •Confused with high blood pressure and high blood sugar levels •"Caused" by excess blood that migrates to one part of the body, typically the head •From eating too much rich, sweet or red foods

Therapeutic Uses of Food: African Americans

•Yellow root tea •Cure stomachache, fever, treat diabetes •Peppermint candies •Help diabetes •Sassafras tea or hot lemon-flavored water for colds •Raw onion to break a fever •Turpentine with sugar to cure intestinal worms •Figs and honey eliminates ringworm •Goat's milk with cabbage juice to cure stomach infection •Eggs and milk withheld from sick children

Therapeutic Uses of Food: African Americans

•Infusions from various leaves for colds •Gargle herbal teas or hot water with honey, salt and baking soda for sore throats •Sassafras tea to cleanse the blood •Garlic cures worms

Therapeutic Uses of Food: French Descent

•Heavy (hard to digest) vs light foods (easy to digest) •Light foods for illness •Wet or dry •Depends on how the food is prepared •Wet meal weekly to "cleanse out the system" •Sickness associated with dryness in the body •Acid or nonacid •Avoid acid foods that may cause skin ailments

Therapeutic Uses of Food: Italy

•Liver, red wine, leafy vegetables are good for the blood •Too much dairy makes the urine "hard" •Garlic to prevent respiratory infections •Raw egg or dandelion greens for strength and vitality •Balsamic vinegar and olive oil are health-promoting

Therapeutic Uses of Food: Italy

-Good diet to maintain health -Chicken soup -Tea with honey or lemon or whiskey -Hot milk -Hot whiskey with cloves -Sulfur with molasses as a laxative -Regular use of cod liver oil -Irish Americans may use senna to cleanse bowels

Therapeutic Uses of Food: Northern Europeans

Balance of proper diet Exercise Good relations with family and community Emotional well-being Spirituality Overweight valued as a sign of health Meat consumption may be associated with longevity Extensive use of botanical home remedies

Therapeutic Uses of Food: Recent African Immigrants

•Colic •Tea, soda water, sauerkraut •Cramps •Chamomile tea •Colds •Tea with dried raspberries •Wine •High blood pressure •Cooked garlic •Coughs •Warm beverages •"Sweat out" an illness •Tea with honey and alcoholic spirits

Therapeutic use of food: Poles

First diagnose the illness Determine supernatural cause Dislodge the evil Take measures to prevent reoccurrence Uses herbs, other natural prescriptions to treat symptoms Spirits of ancestors may transmit medical knowledge Bleeding, massage, dietary restrictions, chants, and charms may complete the cure

Traditional African Healers

•Coffee •Tea, strong •Beer •Vodka

Traditional Food Habits of Central Europeans, People of the Former Soviet Union (FSU) and Scandinavia: Ingredients and Common Foods: Beverages

Adaptation and substitutions made with what was available West African, British, French, Spanish and Native American influences produced American Southern cuisine Fried, boiled and roasted Pork, pork fat Corn, sweet potatoes, local green leafy veggies

Traditional Food Habits: Ingredients and Common Foods

Determined by what grows in cooler, damper climates Potatoes, Beans, Beets Cabbage and cabbage family Eggs and Dairy products Pork, Beef, Fish Seafood from the Baltic Fresh fish from local lakes Apples Rye, Wheat, Barley •Dried, pickled, or fermented for preservation •Cucumber pickles •Sour cream •Sauerkraut

Traditional Food Habits: Ingredients and Common Foods in Russian and the FSU

sausage, fish

Traditional Food Habits: Ingredients and Common Foods: Central Europeans, People of the Former Soviet Union (FSU) and Scandinavia

•Hearty and simple •Abundant seafood •Limited foods produced on land •Preservation methods of previous centuries used •Fish dried, smoked or pickled •Milk is fermented or allowed to sour •Preserve foods with salt

Traditional Food Habits: Scandinavians

•German biomedicine uses botanicals extensively •Illness may be believed to be caused by infection or stress •Expected consequence of hard labor •Dress properly, avoid drafts, breathe fresh air •Exercise, work hard •Take cod liver oil •Suffering is "a blessing from God" •Lots of home remedies used

Traditional Health Beliefs and Practices: Germans

•Health maintained through marimé •Purity and pollution related to Asian Indian beliefs •Separate clean from unclean •Upper body and all secretions pure •Lower half unclean and shameful •Avoid contamination of upper body by touching lower body •Left hand only for personal care •Menstrual blood especially impure •Avoid public places non-Gypsies frequent •Don't touch contaminated surfaces

Traditional Health Beliefs and Practices: Gypsies

•Illness due to •Contact with non-Gypsies •Conditions caused by spirits, ghosts, the devil, or breaking cultural rules •Home remedies •Gypsy healers •Non-Gypsy conditions are suitable for treatment by non-Gypsy physicians •May still consult a non-Gypsy folk healer

Traditional Health Beliefs and Practices: Gypsies

•Fresh air necessary for good health •"Heavy" air of the US vs"Light" air of Italy •Ability to pursue normal, daily activities •Expect health to decline with age •Sickness due to •Contamination through unclean/sick person •Hereditary •Drafts •Suppression of emotions •Supernatural causes •Evil eye •Pregnancy problems due to unsatisfied cravings

Traditional Health Beliefs and Practices: Italian

•Hearty diet •Home remedies, homeopathy, healers common •Sympathy healing •Laying on of hands •Powwowing or Brauche •Charms, spells, and blessings to cure symptoms •Healer acts as God's instrument and requests God's direct assistance in treatments •Reflexology •Herbal Teas

Traditional Health Beliefs and Practices: Pennsylvania Dutch

Shortage of medical supplies in Poland led to widespread use of faith healers Faith in God Religious medals Avoid sick people Healthy diet Sleep Keep warm Exercise Loving home Avoid gossip

Traditional Health Beliefs and Practices: Poles

Natural cures, alternative medicine used extensively Often integrated with biomedical therapy Saunas Massage Steam baths Balneotherapy ◦Bathing in mineral springs Mud baths, sulfurated hydrogen baths Homeopathic preparations and herbals •Magic and the occult •Cure illnesses due to supernatural •Psychics and Znakarki •Elder women who whisper charms and sprinkle water with magic powers

Traditional Health Beliefs and Practices: Russian and the FSU

Fish necessary for good health Norway ◦Cough and cold confectionaries ◦Herbs and dietary supplement boost immune function Finns ◦Natural health care ◦Massage, cupping, bloodletting ◦Sauna used for many things Swedish Massage ◦Relaxation ◦Increase circulation ◦Promote Healing

Traditional Health Beliefs and Practices: Scandinavians

Health maintained through harmony •Illness is caused when someone (dead or alive), the gods, or nature is intentionally malevolent •Magical manipulations •Evil eye

Traditional Health Beliefs of African Americans

Laxatives used regularly Cod liver oil to prevent colds Ingest Vicks VapoRub for colds Copper or silver bracelet worn for protection ◦Darkened skin indicated impending illness ◦Take precautions Health ◦Ability to support family ◦Fulfill social obligations ◦Maintain emotional and spiritual well-being ◦More than just lack of illness ◦Self-empowerment ◦May believe illness is punishment from God Prayer is most important remedy

Traditional Health Beliefs of African Americans

Stress cause of poor health •Cause of hypertension •"Worriation" results in diabetes •Rural South may believe illness is due to evil spirits or witchcraft •Cured by herbal treatments, incantations, magical transference •Yellow root tea used to cure stomachache and fever

Traditional Health Beliefs of African Americans

Traditional herbalists or root doctors Spiritual, sympathy or faith healers ◦Derive power from God May use one or all to treat Healers of all kind use holistic approach ◦Spend lots of time with the patient Not as common today ◦Ill health due to fate or bad luck ◦Home remedies preferred Garlic pills common

Traditional Health Beliefs of African Americans

Combination of Catholic and African beliefs ◦Believed to originate in the Caribbean -Influenced by European witchcraft For good or evil Cure unnatural (supernatural) illnesses ◦Cast spells ◦Use of magic powders ◦Gris-gris bags

Traditional Health Beliefs: Voodoo or Hoodoo

•Food served on communal plate •Meals joyous and noisy •Two meals daily when food in short supply •Men served first, women, then children.

Traditional: African Americans

Scandinavian Americans may be at increased risk for CVD due to

high fat, high cholesterol diet

Meat consumption in Europe is highest in _______, lowest in the _________

northern areas;southern areas

Reasons why African American women practice pica:

•Flavor •Anxiety relief •Texture •Believed to prevent birthmarks •Starch makes baby's skin light •Eases delivery